Monday, 29 December 2008

When the tide goes out

Warning - Low Tide
Warren Buffett's classic quote : "It's only when the tide goes out that you learn who's been swimming naked" may have been about the financial markets, but it's just as applicable to evidence-based care.
One of my current projects is researching the assurance processes used within health and care, to recommend a model for assuring clinical content applicable nationally.
It should come as no surprise, but most of the 'evidence based care' pathways we use may be more 'I'm the expert and this is what I think'. Developing pathways in the past has been down to a medical consultant doing it her/his way, then writing it down and publishing.
In Lean service improvement methodology, one of the first steps is to define the pathway, so there's certainly merit in this. But once it's published, who questions it? Who even measures (accurately) whether it's better or worse than any other pathway, and with what scope of measurement (eg cost for this pathway, vs cost for caring for this group of patients)?
Now I'm certainly not suggesting that you question every pathway. I am suggesting you put appropriate measurement regime in place. And I'm certainly suggesting that you question the assurance process which led to the pathways you use, whether it is robust!
For the record, there are some outstanding assurance processes, including NICE (National Institute for Health and Care Excellence) and NHS QIS (National Health Service Quality Improvement Scotland) which have very robust processes for their legally binding guidelines - but most assurance processes consist of a self-selecting panel (and often on the basis of who's prepared to put the effort in) reviewing to a greater or lesser extent and comparing the results with no others or few other pathways.

Tuesday, 16 December 2008

A focus on Delivery

It's very easy to get caught up in a project. Tied up in the minutiae of doing the next task, keeping track of progress, reporting. The HOW.
Add in a day job (what you're paid to do when you aren't doing the new project) and you can see how quickly you lose track of WHY you are doing this.
But just as you become what you think about, so your project will deliver what you focus on. If you focus on activity, then that's all you will achieve.
Focus on the aims, the goals, the outcomes. If the project aims to reduce smoking, then be mindful of achieving an overall reduction in smoking, rather than just the number of people through the door - stop smoking schemes are a perfect example as too often the same people come back year after year (usually the day for New Year Resolutions).
Of course you have to do the activities from day to day such as running stop smoking sessions. But if it isn't working, then change your approach. Where "is it working?" asks whether it is delivering the benefits you seek

Friday, 5 December 2008

the benefits of networking

NHS Yorks and Humber enjoys an opportunity for a group of like-minded people to share stories and learn new skills, through their Benefits Network which this week was hosted in the NHS Information Centre.
People all over the country want to know more, and take part. Inevitably Y&H simply don't have the budget, and can't stand the uncertainty. So why aren't there more Benefits Networks? Is it a Yorkshire thing to want value for money, so to go out looking for it?
Actually everyone has to look for value. Every SHA and PCT in England has had to take notice of Lord Darzi's 'Next Stage Review' and the final publication, 'High Quality Care for All - Measuring for Quality Improvement'. This demands that commissioners seek quality outcomes, and that providers deliver in a meaningful way, not just activity but real quality outcomes - benefits by another name. This will be reinforced by money - HRG4.0 tariffs will include a component for quality of outcome.
One of the discussions was on the small matter of the growth money reducing in 2011. From right now onwards, we need to decide our priorities, in terms of benefits, and focus on delivering them.
This means developing frameworks for understanding benefits, planning for the benefits from individual initiatives, projects and services or better yet, planning the projects, initiatives and work packages to deliver the benefits desired, and then realising the benefits either (in the short term) through proxy measures, or real and tangible benefits.
Acute service providers are being warned to expect reductions in income of up to 25%. Those hundreds of millions of ££ will be available to invest in community services (which could be provided by acute trust staff and teams with appropriate training), but they must be invested wisely!